Hi Dr Joshi

Perhaps you can tell me why it is that some people have surgery then RT whilst others have surgery and a combination of RT and chemo is it connected with the type of cancer cell being treated? or is it conected to the size or advancement of the tumor?

Thanks for your input

Rosie

This message has been edited. Last edited by: Dr Vinod K Joshi,

Hello Rose

If the cancer is inoperable because it is in an area (e.g. posterio tongue or nasopharynx) where it would cause unacceptable morbidity, radiotherapy and chemtherapy is used to cure/control the primary site cancer with a neck dissection to remove any spread to the lymph nodes in the neck. If the cancer is operable without morbidity, this is preferred as it removes all the cancer cells physically. Radiotherapy and chemotherapy are then added as an adjunct to 'make sure' or get any cancer cells possibly missed at the primary tumour site or lymph nodes. Hope that helps explain these decisions.

Best wishes
Vinod

Hello again Dr Joshi

Thanks for your reply, but I am still unclear as to why some people have RT AND chemo after surgery whilst others only have RT?

Thanks again.

Rosie

Hello Rose

Chemotherapy is often given to shrink a tumour before radiotherapy. More recently, the combination was found to be more successful in advanced stages of cancer and so then this finding has been applied to earlier stages but adding chemo has it's side effects and not everyone is fit enough to withstand its side effects. So if chemotherapy is not necessary, it is not given. Hope that clarifies the matter.

Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,

Hi Rose,
A combination of Chemo and RT DOES statistically improve your chances of overall recovery. It is obviously harder for the patient who has to suffer both these treatments.
I do think though that the much greater COST of the combination treatment enters into the equation.
I just had the surgery (radical neck dissection and tonsilectomy) and RT.
Trying to get a straight answer from my consultant concerning my treatment didn't result in a clear explanation.
So I think the COST is a major factor. I didn't meet ANYONE during the course of my treatment who had a combination of treatments.
Some NHS Trusts use combination treatments as a matter of course.
I would find it extremely interesting to see stastical results on survival rates from different NHS trusts and relate them to different courses of treatment - especially now that the use of erbitux is likely to be used (cost allowing!!) in treatments.
WE ARE IN THE HANDS OF THE NHS ACCOUNTANTS!!
Sad to say!!

cheers Tony K

Dear Tony,I'm surprised you didnt meet anyone in the course of your treatment who didnt have Chemo/Radiotherapy.Three men in the ward with my Husband all had Neck disections followed by Chemo/Radiotherapy. A friends husband is in hospital at the moment undergoing the same treatment & I know of others who attend the OPD who have had the combined treatment.
If you go into Google, you should be able to find comparative costs & survival rates for the NHS trusts. Good researching!

Fran, can you give us the link you found for comparative costs and survival rates for the NHS hospital trusts. Thanks, Vinod.

Hi Fran,
But that's the particular point I am making! Some NHS Trusts have the funding so that virtually all neck dissection patients have chem/RT as a matter of course and others (in a different part of the country) just have the RT because of funding restrictions. So,obviously, over the course of my treatment I wasn't able to meet any other neck dissection patients who had the chemo/RT because my NHS Trust doesn't give that option.

Accountants rule OK! - patients lives? That's another matter.

PS I am pleased that your husband was able to have both treatments - it couldn't have been easy for him. I found the RT hard enough.
PPS - I believe some NHS Trusts in Scotland are going to be the first in the country to sanction the use of erbitux for head/neck cancer patients - Why not the England/Wales I wonder?

cheers Tony K

Dear Tony

It has been interesting reading on your emails on the RT/Chemo issue. I had never given COST a thought! Why I have no idea as it is pretty obvious really. My father had a neck dissection and then RT only, I only thought he didn't need the Chemo has his cancer wasn't that advanced! Maybe that was the case.......but who really knows. I think I'll keep that bit of information to myself, he doesn't need other things to worry about.

Good luck to you all.

Finally,
on that one - some people have routine full body MRI scans after the initial head/neck one in which the tumour was confirmed.
Again this happens in some parts of the country but not in others.

PS the news on the non sanctioning of amvastin and erbitux/taxotere for bowel cancer patients by NICE - what a crap acronym for a medical body whose actions are anything but!!
What chance of it being sanctioned for head/neck cancers now in England!!

I'm off to live in Scotland or somewhere in Europe where patients lives come first. That poor women who has paid 45000 pounds for her own treatment - it's scandalous and shameful.

it depresses me TonyK

I live in Lincoln my husband has just passed away after surviving tongue cancer last year,nasty bowel tumour dignosed just after christmas, which the surgeon told me would have certainly been there when the tongue cancer was diagnosed,I did ask why patients weren't fully scanned when first diagnosed, only to be told 'oh we wouldn't do that'!!!! my husband was 64 far too young to die, what price a life

Hello Carol

I am sorry to hear your husband has passed away. Loosing someone you love and shared your life with is always painful and saddening. I wish I could console you but it is always difficult to know what to say at moments like these. MRI scans and chest x-rays are done when it is suspected that the cancer might have spread. The surgeon probaly felt the tongue cancer was contained localised to within the lymph nodes and so felt the scan unnecessary but in a perfect world, a whole body scan would be done.

Take care.

Best wishes
Vinod

Hello again everyone

Reading these e amils has made me realise how little is known about the best way to treat cancer.

Surely if more was known there would be a standard procedure of treatment which all health authorities would implement.

Seemingly some experts feel that surgery and RT alone is enough whilst other feel that surgery and RT/chemo has a better chance. There must be research somewhere which clearly shows the best result.

Surely it must work out more expensive if patients have to come back again for treatment.

I do appreciate that some patients may not be strong enough to cope with the combined therapy but surely they should be given the full facts and figures and the choice?

I was one of those who only had surgery and RT, I was not aware at the time that chemo as well may have been an option. As it happens I am recovering really well and feel positive that the problem has now been dealt with.

Like Tony I thought that my treatment was based on size/advancement of my tumour, but I am beginning to realise that cost of treatment may have also been a factor.
What price a life??

Regards to all

Rosie

Hello Rosie

Treatment of cancer is always at a cost to the patient. The onologists and surgeon have to weight the chances of getting a successsful outcome at minimal cost to the patient. The decision on the treatments depends on the type of tumour, tumour site, tumopur extent/size and lymph node spread, patient's age and health. There is clincal research into what works best for the different sites and stages, etc. That only points to a generality which may not apply to the individual. And when a new treatment is introduced, there is again a whole new learning curve to go through before some clarity of how best and when to use it. So more reserch is always needed.

The above is then made even more complex when cost (to the NHS ) of the newer (still being proven) treatments enters the decision making!

Best wishes

Vinod